Goggles Target Pressure Differentials in Glaucoma

The idea for Equinox, and the first non-surgical, non-drug treatment for glaucoma, came to John Berdahl, MD, while he and his wife were scuba diving. People with high intraocular pressure (IOP) could wear the company’s Balance Goggles overnight to alleviate pressure on and around the optic nerve. Dr. Berdahl, Equinox founder and CEO, reported on the device during the “What’s the Future?” session at OIS@ASCRS 2016.

Breaking with the traditional thinking of glaucoma as a one-pressure disease, Dr. Berdahl came to view glaucoma as an imbalance between IOP and intracranial pressure. “If IOP is high and intracranial pressure is low, a pressure differential is created across the optic nerve, the nerve cups backwards, and glaucoma ensues,” he said.

When scuba diving, the entire body is subject to 760 mmHg of pressure everywhere at a depth of 30 feet. “I thought, why don’t scuba divers get glaucoma? It turns out that those pressures are being applied everywhere on the body, and those pressures move in lockstep,” Dr. Berdahl said. “No new pressure differentials are created”

Further study showed that people with glaucoma typically have low intracranial pressure and those with normal-tension glaucoma have even lower intracranial pressure, thus explaining why people with normal and low IOP can get glaucoma.

“We envisioned decoupling the eye pressure from the intracranial pressure with a pair of depressurized [depressurizing?]goggles,” he said. The goggles create a small vacuum – 10–15 mmHG – “and release some of the pressure being applied by the atmosphere to the eye,” Dr. Berdahl said.

The goggles will likely be a class II device and “a number of patients” are involved in a safety and efficacy study, but no results are available yet, he said.
In audience polling, 59% said the most compelling advantage of the goggles is to control IOP, 13% said compliance, and 30% said the ability to work synergistically with existing treatments. In a second poll, 71% said the future was bright for Equinox.


John Berdahl

John Berdahl, MD

John Berdahl, MD is Founder and CEO of Equinox and a practicing ophthalmologist whose honors include national recognition as winner of the Resident Writers Award, the Claes Dohlman Award which is given to the top cornea fellow in the country, top 40 under 40 ophthalmologists in the world, and the top young physician in South Dakota in addition to top 40 under 40 business leaders in the Dakotas.

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